Chemotherapy-Related Fatigue Persists Over Time

New data show, surprisingly, that patients who undergo chemotherapy for breast cancer may develop fatigue that remains problematic long after they complete treatment.

“Our results suggest that healthcare providers communicate to breast cancer patients, particularly those who are receiving chemotherapy, the possibility that fatigue may not improve over time and possibly may worsen,” Paul B. Jacobsen, PhD, with Moffitt Cancer Center and Research Institute in Tampa, Florida, and colleagues said.

The investigators assessed fatigue 6 months and 42 months after the completion of adjuvant therapy in 205 breast cancer survivors and at a similar time interval in 193 women without cancer who were within 5 years of age and lived in the same zip code as their patient match.

The current analysis follows an earlier study by the same research group indicating that fatigue was greater immediately after treatment in women who had received chemotherapy alone than in women who received chemotherapy with radiation or radiation therapy alone, as well as in women with no history of cancer. Six months later, the women in the chemotherapy-alone group reported more fatigue than the combination therapy group, the radiotherapy group, and the noncancer group.

In the follow-up study, fatigue was assessed using two widely validated patient-completed questionnaires: the Fatigue Symptom Inventory (FSI) and the Profile of Mood States-Fatigue Subscale (POMS-Fat).

Contrary to what the authors had anticipated, a significant (P = .041) group X time effect for FSI severity scores indicated that fatigue worsened over time in the chemotherapy group but remained stable and lower in the radiotherapy and noncancer groups.

The analysis also showed significant group effects for FSI days (P <.001) and POMS-Fat scores (P = .010), which demonstrates that fatigue was significantly greater across time in the chemotherapy group than in the noncancer group (POMS-Fat) or the radiotherapy and noncancer groups (FSI days).

The authors cited weight gain as a possible mechanism for the persistent or worsening fatigue in chemotherapy patients. In a prior study, an increase in weight from pretreatment to 6 months after treatment in patients who received adjuvant chemotherapy was associated with an increase in fatigue.

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Our results suggest that healthcare providers communicate to breast cancer patients, particularly those who are receiving chemotherapy, the possibility that fatigue may not improve over time and possibly may worsen. ”–Paul B. Jacobsen, PhD

They further commented that their findings are in line with clinical practice guidelines from the National Comprehensive Cancer Network recommending that breast cancer survivors be routinely monitored for fatigue in the posttreatment period, particularly those who received chemotherapy. Patients should also be warned that fatigue may continue and possibly worsen, and treatment options such as cognitive behavioral therapy and exercise should be discussed.